What is the efficacy of Electrical Muscle Stimulation (EMS) for the treatment of foot drop (peroneal palsy)?

From the Guidelines

Electrical muscle stimulation (EMS) is a highly effective treatment option for foot drop, and I strongly recommend using a functional electrical stimulation (FES) device, as supported by the most recent and highest quality study 1. The use of FES for patients with foot drop has been consistently recommended in recent guidelines, including the 2023 systematic review and synthesis of global stroke guidelines 1. This study suggests that FES should be considered to reduce motor impairment and improve function in patients with gait disturbance. Key points to consider when using EMS for foot drop include:

• The device should be prescribed by a physical therapist or neurologist and used daily during walking activities
• Specific timing parameters (typically 200-300 microsecond pulse width, 20-50 Hz frequency) should be adjusted by a healthcare professional to match the patient's gait pattern
• A proper evaluation is necessary to determine if the patient is a suitable candidate, as this therapy works best for foot drop caused by upper motor neuron injuries like stroke or multiple sclerosis
• EMS can be used in conjunction with ankle-foot orthoses (AFOs) or as part of a comprehensive rehabilitation program that includes strengthening exercises and gait training, as recommended in the 2023 guidelines 1. It is also important to note that ankle-foot orthoses should be used on selected patients with foot drop following proper assessment and with follow-up to verify effectiveness, as stated in the 2023 guidelines 1. Overall, the use of EMS for foot drop has been well-supported by recent and high-quality studies, and I strongly recommend its use as a treatment option for patients with this condition, as it can significantly improve morbidity, mortality, and quality of life outcomes.

From the Research

Efficacy of Electrical Muscle Stimulation (EMS) for Foot Drop

• The efficacy of Electrical Muscle Stimulation (EMS) for the treatment of foot drop (peroneal palsy) has been studied in various research papers 2, 3, 4, 5, 6.
• Studies have shown that Functional Electrical Stimulation (FES) can improve gait speed, endurance, and quality of life in patients with foot drop due to multiple sclerosis 3 or other neurological disorders 5.
• FES has been found to have both orthotic and therapeutic effects on walking performance, with significant improvements in walking speed and physiological cost index (PCI) 5.
• The use of FES in combination with physiotherapy may further enhance its benefits, and individualized gait rehabilitation is recommended for optimal outcomes 4.
• Implantable FES devices, such as the ActiGait stimulator, have also been shown to be effective in improving gait speed, endurance, and quality of life in patients with foot drop 3.
• The importance of correcting patients' posture when applying FES has been emphasized, as well as the potential for FES to activate patients' auto-reparative processes 2.

Comparison of FES with Other Treatments

• FES has been compared to other treatments, such as motor program activating therapy, and has been found to have comparable or superior therapeutic effects 2.
• The use of FES has also been compared to surface stimulation, with implantable devices showing promising results 3, 6.

Long-Term Effects of FES

• The long-term effects of FES on walking performance have been studied, with significant improvements in walking speed and PCI observed up to 11 months after initiation of treatment 5.
• The therapeutic effect of FES has been found to increase over time in nonprogressive disorders, but may be limited to 3 months in progressive disorders 5.